Ergonomics

STAY SAFE:  Apply ergonomic techniques throughout the workday

The term “ergonomics” comes from the Greek words “ergo” (work), and “nomos” (law).  Ergonomics is the study of how we interact with our physical environment while at work.  For ultrasound, ergonomics looks at how the operator interacts with the ultrasound system, and how they position themselves relative to the system and to the patient.

Good ergonomics is very important in ultrasound because of the risk to the operator of work-related musculoskeletal disorders (WRMSD).  These are injuries to wrist, elbow, shoulder, neck, and back from repetitive scanning motions that put undue stress on these areas.  Repetitive strain injury is another term for these types of injuries.  

WRMSD is a significant problem in diagnostic ultrasound.  It is estimated that up to 80% of sonographers can be impacted by WRMSD during their careers and that of those who continue to scan in pain up to 20% may have to change careers. In the early years of ultrasound, the equipment was not ergonomically well-designed and sonographers were not as aware of the issues.  Today, the equipment’s ergonomic design has definitely improved, as has awareness of the problems.  However, all sonographers must have a solid understanding of good ergonomic scan techniques and put them into practice for each and every scan.

The following is list of some of those good ergonomic techniques:

• position yourself as close to the patient as possible.  Move the patient close to you and raise the bed to a level that allows you to scan with your arm in a neutral position 

• use a scan bed that is very adjustable, preferably with electronic controls 

• avoid excessive abduction (reaching) of either the scanning arm or the keyboard arm

• support your scan arm where possible

• grip the transducer with the palm of the hand rather by the finger tips.  Avoid the “pinch grip”

• avoid excessive wrist flexion or extension, both in the scan arm and the keyboard arm

• support the transducer cable.  Do not allow the transducer cable to exert extra pressure on the scanning hand

• become familiar with and utilize adaptive equipment when scanning, such as support cushions, wrist braces 

• stand and use body weight if extra transducer pressure is needed

• position the monitor at eye level to avoid neck strain

• dim the lights in the scan room to avoid eye strain

• alternate between sitting and standing during the day

• use anti-fatigue matting when standing to reduce leg strain

• sit in an upright position with your lower back well-supported

• try to keep your shoulder blades relaxed and down.  Do not hunch or let your shoulders roll forward

• scan a variety of different exams during the day.  Try not to perform the same type of scan repetitively.

• take mini-breaks during each scan throughout the day

• perform short stretches throughout the day

• do some strength training for arms, back, neck, shoulders, and core 

Should you find yourself developing any type of pain from scanning, seek immediate attention.  The earlier the issue is dealt with, the more likely it can be dealt with effectively. 

Use ergonomic devices to assist with scanning

This task builds on the information provided in the previous section.  One of the key principles of good ergonomics is support.  As we saw in the previous section it is important that the sonographer properly support themselves while scanning.  This support extends from good support when sitting to good support for both arms.

There are devices that can provide support.  These include:

• cushions or support pads for the patient so that they can maintain an oblique or decubitus position without placing additional strain on themselves or the sonographer

• foam support pads for the sonographer’s arm/wrist

• keyboard wrist supports 

• transducer cable supports.  Cables should not be allowed to dangle and add additional weight to the transducer.  Some systems come with cable supports or these can be purchased after-market.

• cable support arm braces are also available that attach the transducer cable to the sonographer's arm with Velcro.  These can assist in reducing some of the weight of the transducer cable. 

• sling supports that support the sonographer's arm from the ceiling have also been developed.

• an ergonomic chair with good lumbar support

• an anti-fatigue mat when standing

Other ergonomic devices that assist with scanning include:

• voice recognition.  Available on some systems, this allows the sonographer to adjust controls verbally rather than manually.

• well-designed annotation packages.  These can minimize the number of keystrokes needed to annotate each image.   

Provide ergonomic education/training

As sonographers, we are life-long learners.  Indeed, the SDMS Code of Ethics states that sonographers should “maintain continued competence through life-long learning, which includes continuing education...”.  However, we are also life-long teachers because as we gain experience we have a duty to mentor younger sonographers and pass along the wisdom that we have gained.  To that end, one key area in which we can educate both new sonographers, as well as management, is on the importance of good ergonomics and the steps that are required to foster good ergonomics within the workplace.  These steps have been outlined in the sections above.  It is incumbent on all sonographers to have a good understanding of these and to educate younger sonographers, department management, and the public as to the profound importance of good ergonomics within the profession of diagnostic ultrasound.  

For more information see the SDMS document: INDUSTRY STANDARDS FOR THE PREVENTION OF WORK RELATED MUSCULOSKELETAL DISORDERS IN SONOGRAPHY